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Superior vena cava obstruction — SCE Acute Medicine MCQ

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EasyAcute Respiratory PresentationsSuperior vena cava obstructionSCE Acute Medicine

A 51-year-old man presents with acute breathlessness with chest symptoms. Relevant history includes respiratory disease and a relevant acute precipitant. On assessment, respiratory distress is present with abnormal oxygenation. Investigations show facial swelling, distended neck veins and mediastinal mass. What is the most appropriate next step in management?

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Correct answer: C — Give corticosteroid if severe symptoms and arrange urgent CT-guided oncology assessment

The key discriminator is that facial swelling, distended neck veins and mediastinal mass, which makes Give corticosteroid if severe symptoms and arrange urgent CT-guided oncology assessment the single best answer. Give analgesia and antiemetic therapy is less appropriate because it does not address the dominant acute risk in the vignette; Start broad-spectrum intravenous antibiotics would fit a different presentation or later stage of care. Provide supportive care and close monitoring and Start anticoagulation after assessing bleeding risk are suboptimal because they would either delay time-critical treatment or follow the wrong acute pathway. Teaching point: SCE-style acute medicine questions usually test prioritisation using physiology, timing and a guideline-defined threshold, rather than isolated factual recall.

Reference: NICE suspected cancer guidance